Weight loss and health have a complicated relationship.
In a culture of extremes, with rising obesity and associated disease rates on the one hand the "thin ideal" on the other, health can get lost in the shuffle.

The shift in mindset away from “one size fits all” undoubtedly has its benefits, but is there danger in “fat acceptance”?

Get out those boxing gloves! A battle of philosophy brews in the fight against overweight and obesity.

Health at Every Size?

The rise of supermodel Ashley Graham and the popularity of plus-sized clothing brands are testaments to the trend of “body positivity” in social media, advertising, and apparel, while Health at Every Size (HAES) promotes the idea of “body diversity” and discourages healthcare providers from focusing on weight loss in treatment. For example, Linda Bacon, founder of HAES, cites numerous studies in which dieting appears to not only be ineffective, but to possibly contribute to greater weight gain.

On the other hand, earlier this month, the Journal of the American Medical Association published a study that showed a decrease in the number of overweight and obese people attempting to lose weight over the past three decades. The study authors, as well as media pundits writing about the study, expressed extreme concern about this trend and the implications for health risks associated with obesity.

As the authors put it:“If more individuals who are overweight or obese are satisfied with their weight, fewer might be motivated to lose unhealthy weight.”

Possible “culprits” in this shifting mindset include patients’ reduced motivation due to body weight misperceptions and primary care physicians’ lack of discussion about weight issues.

We cannot deny the continual increase in body weight across almost every demographic in the US and in many other western countries, as well as rates of diabetes, hypertension, and other chronic diseases associated with lifestyle that have, coincidentally, risen in lock-step. I say “coincidentally” because HAES argues that these obesity and disease statistics merely correlate--and, after all, correlation does not equal causation. HAES suggests instead that the underlying lifestyle is to blame--namely stress, inadequate levels of physical activity, and a poor relationship with food.

While the debate continues over whether excess adiposity alone is a risk factor for disease, and whether obesity should itself qualify as a disease, we can most likely all agree that our lifestyles need some serious makeovers. Our health lags severely behind most other “first world nations”. For example, even when controlling for socioeconomic differences, the US holds high rates of mortality for conditions like heart disease and diabetes.

But is focusing on “weight loss” per se the solution to our health problems? Or does it, in fact, actually create more?

Dieting may slow metabolism and reduce muscle mass--which further slows metabolism--making it easier to regain weight.

Many experts cite negative psychological implications from “failing” at dieting/weight-loss. When Huffpost polled a group of experts, many said that this sense of failure can have long-ranging effects, making a person feel incompetent in all areas of life and severely damaging self-esteem.

So...if dieting is so unlikely to be successful, no wonder people give up on it--and give up on the idea of losing weight altogether!

Should we all just say, “Fuggedaboutit”? Are we doomed to be overweight without any remedy in sight?

Weight loss surgery can be effective, but many people don’t meet the requirements for it, can’t afford it, or simply don’t want to deal with its risks and potential side effects.

HAES suggests that, rather than focus on weight loss, we devote energy to coping with the stress that so often contributes to overeating. They also encourage “intuitive eating”: Staying mindful of how different foods make you feel and using this to guide your consumption.

The HAES approach has merit, particularly the emphasis on self-compassion and “anti-shame”.

The Weight-Less Solution

When it comes to health and weight loss, labelling foods as bad/good and healthy/unhealthy contributes to rigidity and confusion. However, learning about nutrition and understanding what comprises the foods that we eat can help us decipher our the body’s signals more accurately.

For instance, a recent study showed that foods containing both fat and sugar tended to elicit “addiction-like” responses. Intuitive eating is a generally valuable approach, but would we suggest that someone take an “intuitive” approach to using cocaine? Perhaps this intuitive approach might serve a purpose with alcohol, along with the warning to “proceed with caution”, as alcohol can cloud judgement.

Using intuition in tandem with nutrition knowledge helps to strip food of the morality that underlies many disordered eating behaviors. Understanding that certain foods can invoke a response that masks our true level of hunger/satiety can better inform our decisions. Rather than inducing feelings of guilt, this inspires a more “intelligent mindfulness”, if you will.

This applies to exercise as well: Trying to burn as many (or more) calories as we consume can feel like a miserable math battle, where the focus lies more on Fitbit stats and less on actually enjoying movement. Exercise is somewhat of a “wonder drug” in that it can improve numerous health metrics, even without weight loss. Yet so many people lose motivation when they don’t see the scale move and/or because they approach exercise as compensation--or even punishment--for what they ate.

Humans are rebellious creatures by nature and will tend to push back against punishment, even if that punishment is self-inflicted. Approaching movement as a fun way to explore one’s own body can completely transform the experience into one that is both pleasurable and empowering.

In summary, NO: Trying to lose weight may not actually improve your health. BUT engaging in self-care, developing coping mechanisms for stress (including getting more sleep), keeping an open mind to learning more about your own body, and working on changing behavior without shame or punishment, CAN.

And remember, bodies come in many shapes and weights. If you're treating your body well, and feeling good mentally and physically, your size is not that important!